HHS “Provider Conscience” Rule Puts Public Health in Danger

As expected, the Bush administration finalized its proposed "provider conscience" rule last week. Despite opposition from leading medical groups like the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Hospital Association; from Senators, House members, and state attorneys general; from officials at the Equal Employment Opportunity Commission; and from over 200,000 individual commentators, the Health and Human Services Department pushed through a rule that expands the right of health care workers to refuse to provide medical care, counseling, referrals, and even information to an unprecedented level.

The rule is pernicious in many ways. It allows all employees, and even volunteers, of most institutions receiving HHS dollars to deny access to a wide variety of medical services. The rule ostensibly protects only employees who object to abortion and sterilization, but it is written so broadly that it could also apply to contraception, fertility treatments, HIV/AIDS services, gender reassignment, end-of-life care, or any other medical practice to which someone might have a personal moral (not even religious) objection.

This rule is not "just a woman’s issue," though the more than 17 million women who depend on our public health system and who are disproportionately low-income and women of color will certainly bear the largest brunt of this politically-motivated regulation. The rule also provides a striking example of how the stigmatization of one medical service-specifically, abortion-can quickly creep into other areas and erode well-established medical standards of care. Allowing medical services to be ranked on a scale of moral superiority is a public health problem.

The right of conscience is an important and time-honored value in our society and one that should not be tread upon lightly. But it is not only health providers who have rights; so do patients. Standards of care and codes of conduct exist to balance the rights of them both. Instead of pitting the rights of providers and patients against one another, perhaps there are a few tenets upon which we as a society can agree:

Withholding relevant, medical information from patients is never good medical practice nor ethical;

Providers who are unwilling to provide certain services must give their patients timely notice of their refusal to do so and must refer those patients to a provider who can supply the needed health care.

Despite the fact that professional medical associations have consistently endorsed these precepts, the new HHS rule ignores all three of these basic yet essential codes. Fortunately, it is likely that the new administration and the new Congress will work to reverse this rule as quickly as possible. But this debate will not end with the demise of this rule, and we must not countenance some very dangerous concepts that have been advanced in support of the rule.

Requiring a health care provider to do his or her job is not discrimination. Employers are required to accommodate an employee’s religious beliefs when doing so does not present an undue hardship on the employer. However, refusal or withdrawal of health care in a manner that neglects a patient’s needs is an undue hardship and should not be entitled to accommodation.

Providing a referral for a service is not morally equivalent to providing that service yourself. There are varying degrees to which one’s conscience may be burdened by certain actions. Supplying information about where to find appropriate medical care ought not to tax one’s conscience to the same extent as performing a procedure or dispensing medication. Moral beliefs exist along a continuum and the protections afforded for such beliefs must be proportionate as well.

A refusal to provide care can harm patients. In our current health care system, we face a shortage of primary care physicians, a nursing shortage, a vast population of uninsured and underinsured patients, hospitals that cannot afford to stay open, and rural communities with few health care resources like clinics and pharmacies. Health care providers should not assume that just because they say no, a patient will be able to find another provider who will say yes who is also affordable and accessible.

The so-called "provider conscience" rule disrupts the careful balance established by medical codes of conduct and standards of care, placing the health, well-being, and dignity of patients at risk. We must work to ensure the proper balance is restored quickly, so that we can continue to protect the right of conscience while also protecting access to all health care services for every patient who needs them.

“Requiring a health care provider to do his or her job is not discrimination. Employers are required to accommodate an employee’s religious beliefs when doing so does not present an undue hardship on the employer. However, refusal or withdrawal of health care in a manner that neglects a patient’s needs is an undue hardship and should not be entitled to accommodation.”

Amazingly put.

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…conservatives wondering why they are still in the GOP? By aligning themselves with the fiscal (“free market”) conservatives in the same party, they were doubly-betrayed in November when irresposible Wall Street execs got a $700B handout AND their man McCain lost. Many of those who still vote Republican have lost their job/house/child-spouse-sibling to Iraq/credit score and it all can be traced to White House policy going back almost eight years. Others like them who voted GOP in ’04 and ’00 have “seen the light” and either switched or stayed home on November 4. They all made a deal with the Devil to protect the unborn and passive-aggressively bash gays and look where it got them?
Not to diminish the scope of the HHS ruling, because if not beaten-down swiftly/decisively it will corrode the very meaning of the noun “professional” in American life (not just in Medicine), but the need to place this regulation is politically motivated if the GOP can even hope to be a contender by 2012.
It may already be too late, one can hope. A fair portion of the Religious Right saw the effect of deregulating environmental rules in their own backyards and know that God’s green Earth is not so “green” these days, harkening back to memories of T-shirts proclaiming the Lord’s return “and He’s Gonna Be Pissed!” This environmentally-conscious wedge should used to drive home a delicate but logical point: abortion-providers may be a woman’s last line of defense, but they are also the last hope for lowering the unleashing of the world’s most hazardous waste: unwanted people.

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12-4-08 – 1015: that’s mine! I have no need to be Anon. Also, the only “?” appearing above should have been a period. Please accept my apologies for any confusion that may have resulted from my not thoroughly scrutinizing the text during the Preview.

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“Requiring a health care provider to do his or her job is not discrimination. Employers are required to accommodate an employee’s religious beliefs when doing so does not present an undue hardship on the employer.” Hmmm. Although she doth protest, I think we all know that this column is about abortion and the attempts made since Roe v. Wade to make us all accept it as a moral choice.

Consider that 46 states have enacted “provider conscience laws” to protect medical personnel who are pressured to perform “jobs” they find morally unacceptable. Restoring balance is exactly why those laws were enacted.

Consider that a hospital requiring medical personnel to perform “jobs” against their consciences will very likely wind up losing those personnel. Yep, that’ll help the situation. By the way, abortion on demand is not a “job” exception in abortion clinics.

Consider that, like all other Americans, medical personnel have a CONSTITUTIONAL right to their religious beliefs. The day the US makes a medical care provider perform a “job” against his/her conscience is the day we can start kissing our liberties good-bye. We have a history of protecting religious beliefs in this country, a right of our Nation’s founding. You don’t have to agree with any religious belief, but our beliefs ARE protected.

Consider that, if there are so many pro-choice medical professionals in America (evidence: the AMA’s endorsement of FOCA), why worry that a woman would not be able to find a provider who agrees with her choice? All she has to do is look in the Yellow Pages; I know Planned Parenthood is happy to help.

Consider that the ability to provide any service in any hospital is the administrator’s job, as are hiring practices. An able administrator should be able to balance the need for services with the number of pro-choice/pro-life personnel on the staff so as not to place an “undue hardship” on the hospital/employer. I suppose you could make being pro-choice a condition of employment. Why would that be any more unethical that denying a doc/nurse a conscience “choice”?

While I agree with the societal tenets Ms. Arons proposes, I suspect that Jessica won’t be satisfied until all consciences are like hers.

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…so why does one use broad generalities to give US the impression that a female can get abortion counseling everywhere in this country, and even when “conscience” interferes, there’s the local Planned Parenthood right down the block? And what planet are you from, with hospitals closing left and right, that “conscience” personnel can so easily be absorbed by hospitals of “conscience?” Maybe, and I emphasize that word MAYBE, there is some middle ground where a “professional” can cite conscience to legitimize not performing the full service of their profession as they are empowered BY LAW, but Kathleen, you’d have US go down a slippery slope with feel-good “conscience” rules with severe consequences for those who end up in the wrong place at the wrong time.
An example which just came to mind is another part of the hospital, the ER. And you medical professionals out there should feel free to help me out, since I am not one: A young adult female staggers into the Waiting Room bleeding from several portions of her body. With all manner of expenses and cutbacks the hospital currently suffers, there is only one physician on staff this early in the morning and everyone else is out sick with the flu or attending other patients. The MD hurriedly stops the bleeding and asks a whole bunch of questions, noting the smell of alcohol on her breath. She tells him, gaspingly, that she was waiting for her return flight and had a pork dinner at a restaurant two blocks away and was attacked as she reached her rental car in the deserted car park 1 block away. Her purse and the car were taken after the perp raped her, suddenly, she stops breathing.
Should be cut-and-dried, right? Doc does what he can to stabilize her and when he gets a free moment (one way or the other, reports the crime to the cops, who will know the car from airport rental/surveillance video and have the perp in custody in an hour. There’s just one catch: the fully-qualified AND LICENSED MD is an Afghani immigrant and is a Muslim somewhere in between wahabbist and Taliban in belief. Making sure that rapist’s seed doesn’t find her egg is the least of that victim’s worries if the physician’s conscience prevails!